GEICO Sues Clinics for $5.2 Million in Fraudulent Billing under PIP Laws

GEICO has initiated a lawsuit against six clinics in the Miami area, claiming they fraudulently billed over $5.2 million for unnecessary or nonexistent medical services under Florida's personal injury protection (PIP) system. Filed on July 6, 2026, in the Southern District of Florida, the lawsuit names the clinics, their owners, and designated medical directors as defendants. GEICO is pursuing compensatory and treble damages under the federal RICO statute, along with a legal determination of non-liability for outstanding claims.

This case underscores the vulnerabilities within PIP coverage, intended for essential medical treatments post-accident. GEICO asserts that services billed by these clinics failed to meet medically necessary criteria. The insurer alleges these facilities operated as fronts, primarily submitting fraudulent PIP claims starting before 2021.

GEICO describes a systematic fraud involving fictitious treatment protocols designed to inflate billings instead of addressing actual medical needs. They claim most insured individuals did not suffer significant injuries but were subjected to similar medical procedures like exams, therapies, and imaging, each purportedly justifying further unnecessary treatments.

The lawsuit details billing practices, noting initial exams coded under CPT 99203, costing between $250 to $350, varying by clinic. Additional charges were applied for treatments such as ultrasound, traction, and manual therapy.

Significant attention is directed toward service providers, particularly under Florida law that, since 2013, prohibits PIP payments for services by massage therapists. GEICO alleges these billed "physical therapy" services involved massage therapists, unsupervised physical therapist assistants, and unlicensed personnel.

The suit raises concerns about oversight by medical directors, whom GEICO claims were largely absent, noting rare appearances at the clinics. Furthermore, GEICO accuses these entities of failing to collect copays and deductibles, actions that could violate Florida’s insurance fraud statutes.

GEICO specifies payments to these clinics as more than $2.08 million, $821k, $938k, $1.05 million, $320k, and $71k, aiming to deny liability for pending claims surpassing $75,000. The lawsuit includes 36 counts, covering allegations of RICO violations, fraud, and unjust enrichment, which are pending adjudication in court.